Cardiothoracic ratio may be misleading in the assessment of right- and left-ventricular size in patients with repaired tetralogy of Fallot.

AIM: To assess the relationship between cardiothoracic ratio (CTR) and ventricular and atrial volumes in patients with repaired tetralogy of Fallot (TOF). MATERIALS AND METHODS: Patients with repaired TOF undergoing cardiac magnetic resonance (CMR) and chest radiography within 1 day were included (n = 82; median age: 24.7 years, interquartile range: 21.5-35.9). The CTR was obtained from upright posteroanterior chest roentgenograms. Analyses of CMR images and radiographs were performed in a blinded fashion. RESULTS: There were 35.1% (13/37) of patients with normal CTR (<0.5) who had severe right ventricular (RV) dilatation. There were six patients (13.3%, 6/45) with high CTR with both normal RV and left-ventricular (LV) volumes. CTR did not correlate with either RV or LV volumes but showed a weak correlation with right- and left-atrial volumes (r = 0.43, p = 0.0001; r = 0.27, p = 0.01, respectively). CTR ≥0.5 showed poor ability in the identification of severe RV dilatation (sensitivity: 61.8%, specificity: 50%). The combination of CTR and signs of RV enlargement on lateral radiographs did not improve the diagnostic accuracy of any of those parameters alone. CONCLUSION: CTR in patients with repaired TOF reflected atrial rather than ventricular dilatation. The use of CTR or lateral radiographs in patients with repaired TOF may lead to false conclusions concerning ventricular size.

Analysis of the origin and importance of acetone and isopropanol levels in the blood of the deceased for medico-legal testimony.

UNLABELLED: The aim of the study was to analyze the incidence of acetone and isopropanol in the blood of the deceased, and to assess cases in which the compounds have been detected with a focus on their origin and usefulness for medico-legal testimony. MATERIAL AND METHODS: The study material consisted of results of tests detecting ethyl alcohol and reports of autopsies performed at the Department of Forensic Medicine, Medical University of Warsaw, from January 2008 to April 2009 - a total of 2,475 cases. The test group proper (group B) comprised only those cases in which acetone was detected in blood, either with or without isopropanol [n = 202 (8.2%)]. The blood levels of isopropanol varied depending on the cause of death. The need for differentiating the origin of isopropanol in the case of its presence in the blood of the deceased was pointed out. RESULTS: The results of the present study show that the differentiation should be based on the isopropanol and acetone concentration ratio, as isopropanol concentration alone is not sufficient for preparing expert opinions. Even high concentrations of isopropanol, when accompanied by even higher concentrations of acetone, imply that isopropanol could have been formed as a result of acetone transformations. Isopropanol concentrations exceeding acetone levels strongly point to the exogenous origin of isopropanol, particularly when high levels of ethanol are concurrently detected.

Stable right ventricular size and function during short-term follow-up in patients with pulmonary regurgitation after tetralogy of Fallot repair.

AIM: To assess changes in ventricular size and function over time in conservatively treated adult patients with repaired tetralogy of Fallot (TOF) and significant pulmonary regurgitation (PR). MATERIALS AND METHODS: Patients with repaired TOF who had undergone more than one cardiac magnetic resonance study were identified. To confine the cause of ventricular size and function deviation to PR, patients with residual ventricular septal defect, more than mild regurgitation at a valve other than the pulmonary valve, and known coronary artery disease were excluded. RESULTS: The final analysis included 27 adults with PR fraction >20%. During a follow-up of mean 2.1 ± 0.8 years, there was no change in right ventricular (RV) end-diastolic volume (EDV; 162.1 ± 27.6 versus 164 ± 29.6 ml/m(2), p = 0.5). Left ventricular (LV) EDV showed a small decrease (85.1 ± 16.2 versus 81.5 ± 14.1 ml/m(2), p = 0.02). The mean PR fraction, PR volume, and peak RV outflow tract gradient did not change. Additionally, both RV ejection fraction (EF) and LVEF remained stable over the follow-up period (48.1 ± 6.5 versus 48.4 ± 6.7%, p = 0.83, and 57.3 ± 5.4 versus 57.2 ± 5.1 %, p = 0.91, respectively). Only two asymptomatic patients (7.4% of the study group) developed symptoms and the remaining did not deteriorate. CONCLUSION: The RVEDV, RVEF, and LVEF remained stable over a mean follow-up of approximately 2 years in the majority of adult patients after TOF repair with significant PR and a wide range of RVEDV.

Primary transcatheter closure of postinfarction ventricular septal defects with the Amplatzer septal occluder- immediate results and up-to 5 years follow-up.

AIM: To report the periprocedural and long-term results of using the Amplatzer septal occluder for primary closure of post myocardial infarction ventricular septal defects. METHODS AND RESULTS: Transcatheter closure was considered in patients with significant left-to-right shunting and defect anatomy and location thought to be suitable for closure with such a device. From December 1999 until February 2005 eleven patients (9 males) aged 52-81 years (mean 67,9) underwent an attempted closure. The time from the onset of infarction to the procedure ranged between 2 days and 58 weeks (mean 15,4 weeks). There were three patients in an acute phase of infarction (three weeks or less). They were in critical condition and required inotropic and ventilatory support. Eight patients (all in a chronic infarction phase) were hemodynamically stable and in NYHA class III-IV (6 patients) or class II (2 patients). A successful device implantation occurred in all but one patient, in whom a 26 mm occluder pulled through a 16 mm defect on day 8 of infarction. An infarct exclusion surgery was successfully performed in this patient. In the remaining 10 patients, the defect size ranged 8-21 mm (mean 14,3), and the devices 11-30 mm (mean 19,3) were implanted. The procedure and screening time ranged 134-286 (mean 187,2) and 23-90 minutes (mean 43,6) respectively. The successful implantation did not clinically succeed in both patients with the acute septal rupture - they died 2 and 15 days after the procedure. In the eight patients in whom the procedure was performed late (3,5-56 weeks) after the infarction onset, the defect was either completely closed or the shunt was insignificant, and they improved dramatically. In the most recent follow-up from 1 to 62 months (mean 25,5), the patients have been alive and feeling well, and in NYHA I or II class. CONCLUSION: Primary transcatheter closure of postinfarction ventricular septal defects may be an alternative to surgery in patients with suitable anatomy and completed necrosis. In our experience, primary transcatheter closure of ventricular septal defects in patients who are in the acute phase of infarction does not improve their survival.

Transcatheter closure of a 16 mm hypertensive patent ductus arteriosus with the Amplatzer muscular VSD occluder.

There is little experience with transcatheter closure of very large, hypertensive patent ductus arteriosus. We present a case of successful closure of a 16 mm ductus with the Amplatzer VSD occluder, a device originally designed for transcatheter closure of congenital muscular ventricular septal defects. To our best knowledge this is the largest ductus ever closed by an interventional technique.

Transvenous closure of moderate and large secundum atrial septal defects in adults using the Amplatzer septal occluder.

The aim was to determine the feasibility of using the Amplatzer septal occluder for closure of moderate and large secundum atrial septal defects in adults. Fifty patients aged 16-76 years (mean +/- SD, 40 +/- 15.5), underwent successful device implantation. Flow ratios of 1.4-8.5 (mean +/- SD, 2.6 +/- 1.6) were calculated. The defects were: centrally placed (n = 31), antero-superior with partial or total deficiency of aortic rim (n = 19), multiple (n = 3) and with aneurysmal septum (n = 23). They measured 4-25 mm (median 14) on echocardiography and balloon sized 7-31 mm (median 19.5). Devices of 7-34 mm (median 20) were implanted. Patient follow up for 1 month (50/50 patients), 3 months (40/50) and 12 months (13/50), achieved respective rates of 90%, 92% and 98% of complete occlusion. In one patient a transient atrioventricular block (2:1) developed, and one had a transient STT elevation. One female had an episode of 30 min loss of vision over the lateral aspect of the left eye 3 months after implantation. In conclusion, transvenous occlusion of secundum atrial septal defects with the Amplatzer septal occluder in adults is safe, and can be performed without significant complications. Large defects, defects with a very deficient or absent aortic rim, defects with an aneurysmal septum as well as some multiple defects can be closed with an almost 100% early complete occlusion rate. This makes the procedure an alternative to surgery for selected adult patients.

Left ventricular outflow tract gradient decrease with non-surgical myocardial reduction improves exercise capacity in patients with hypertrophic obstructive cardiomyopathy.

OBJECTIVES: This study was undertaken to evaluate mid-term clinical results of non-surgical myocardial reduction in patients with hypertrophic obstructive cardiomyopathy. METHODS: Twenty-five patients with left ventricular outflow tract obstruction (mean gradient of 84. 54+/-31.38 mmHg) and symptoms of dyspnoea, angina and/or syncope were treated with non-surgical myocardial reduction. The patients were followed-up for a mean period of 10.44+/-1.8 months. In all patients clinical examination with echocardiography was repeated after every 3 months of follow-up, and a symptom-limited treadmill test was repeated at the 6 month follow-up. Eighteen patients underwent simultaneous respiratory gas analysis. RESULTS: Clinical follow-up examinations were achieved in all 25 patients. Persistent left ventricular outflow tract gradient reduction was seen in 23 patients. Seventeen patients had a reduction of left ventricular outflow tract gradient >50% of baseline value. Twenty patients showed a clinical improvement from 2.8+/-0.5 up to 1.2+/-0.5 NYHA class (P<0.001). The clinical improvement was matched by an improvement in objective measures of exercise capacity in patients with significant left ventricular outflow tract gradient reduction. Exercise time increased from 571.9+/-192.2 to 703.5+/-175.4 s, P<0. 001, and peak VO(2)increased from 14.6+/-5.2 to 20.5+/-8.6 ml. kg(-1)min(-1), P<0.05. CONCLUSION: Significant left ventricular outflow tract gradient reduction with exercise capacity improvement was achieved in the majority of patients treated with non-surgical myocardial reduction. We recommend this method as an alternative to surgery for symptomatic patients with hypertrophic obstructive cardiomyopathy.

[Transcatheter closure of patent foramen ovale in patients after cryptogenic stroke]. / Przeznaczyniowe zamykanie droznego otworu owalnego u chorych po udarze niedokrwiennym.

Paradoxical embolism through a patent foramen (PFO) is a possible mechanism of ischaemic stroke in patients with cryptogenic stroke. Occlusion of PFO in such patients is considered by some authors as most effective in stroke prevention. We present our initial experience with transcatheter closure of PFO with the new self-expanding device--the Amplatzer PFO occluder in three young patients (age < 50 years). Each of them experienced at least one ischaemic stroke episode, without a left heart or carotid source and each had an interatrial communication with right-to-left shunting during Valsalva manoeuvre on echocardiography. The PFO's were closed completely without complications, under transoesophageal echo guidance in general anaesthesia. Complete closure was confirmed at one-month follow-up echocardiogram in each patient. No repeat cerebral accidents occurred at that time. The procedures were relatively easy and the clear presentation of the implant on TEE and fluoroscopy, made implantation fully controlled. The unique feature of the device is, that until release it can easily be retrieved, repositioned or removed. Transcatheter closure of PFO with the Amplatzer PFO occluder may become the new therapeutic option for patients with cryptogenic stroke and presumed paradoxical embolism.

Long-term follow-up results of balloon valvuloplasty for congenital aortic stenosis: predictors of late outcome.

AIMS: Long-term follow-up of patients with aortic valve stenosis undergoing balloon valvuloplasty was evaluated with respect to survival, the need for repeat intervention and factors predicting late outcome. METHODS AND RESULTS: Forty-five patients between 3.5 to 23 years old (mean 11.7 +/- 4.5) were followed for 62 +/- 30 months (range 11-122). The transvalvar aortic gradient decreased from 84 +/- 20 to 36 +/- 10 mmHg (p < 0.001) and remained significantly lower (50 +/- 26 mmHg; p < 0.001) at follow-up. At that time, 10 patients (including 4 with significant valve incompetence) had gradients >/= 60 mmHg. The procedure resulted in significant valve incompetence (grade >/= 3) in 8 patients (17.8%). There was a progression of incompetence and 13 patients (28.9%) had significant regurgitation at follow-up. All survived. Fifteen patients (33.3%) required re-intervention 51 +/- 24 months after valvuloplasty. The indications were: aortic stenosis in 5 patients; regurgitation in 6 patients; and stenosis with regurgitation in 4 patients. Actuarial freedom from re-intervention at 2, 4, 6 and 8 years was 96%, 88%, 61% and 56% of patients, respectively. The residual post-valvuloplasty gradient was the only predictor of re-intervention for valve stenosis (odds ratio = 3.2 for every 10 mmHg gradient increase; p = 0.017). A residual post-valvuloplasty gradient >/= 40 mmHg increased the relative risk of re-intervention sixfold. The immediate post-valvuloplasty aortic regurgitation grade was the only risk factor of re-intervention for regurgitation (odds ratio = 34 for every incompetence degree increase; p = 0.0019). Incompetence grade >/= 2 increased the risk of re-intervention tenfold. CONCLUSIONS: Valvuloplasty carries the risk of development of valve incompetence, which progresses with time. Some patients develop restenosis. The

High-Pressure Bail-out Coronary Stenting Without Anticoagulation: Early Outcome and Follow-up Results.

PURPOSE:The purpose of this study is to assess the immediate outcome and long-term results of high pressure bail-out coronary stenting without subsequent anticoagulation. PATIENTS AND METHODS: Between June 1994 and September 1996, 32 consecutive patients (males 24, mean age 55 +/- 9.3 years) underwent bail-out stenting at a mean deployment pressure of 15.5 +/- 2.3 mmHg because of complicated PTCA. A total of 54 stents (Palmaz-Schatz, Micro, Gianturco Roubin and Wiktor) were implanted, from one to four stents into each vessel. After the procedure all patients were treated with ticlopidine 500 mg/day and acetylosalicylic acid 300 mg/day only. RESULTS: Stents were successfully delivered in all patients. In the cath lab procedural success was 96.9%. During the in-hospital phase, there was one (3.1%) acute stent thrombosis followed by urgent bypass surgery (CABG). Four (12.5%) non-Q wave myocardial infarctions occurred. There were no subacute stent thrombosis or hemorrhagic complications. Six month angiographic restudy in 28 patients showed restenosis in 13 (46.4%): 9 patients were treated successfully by rePTCA. At one year 13 (40.6%) major adverse cardiac events occurred: eleven (34.4%) target lesion revascularizations (9 PTCA, 2 CABG), one (3.1%) elective CABG surgery and one (3.1%) late cardiac death. Event-free survival was 93.8% at one month, 65.6% at six months, and 59.4% at one year. CONCLUSIONS: High pressure bail-out coronary stenting with antiplatelet regimen is an effective and safe procedure for treating complicated PTCA. Although the restenosis rate is high, in most cases in-stent restenosis can be treated by rePTCA. In 60% of patients clinical course at one year was uneventful.

[Early and long-term outcome after coronary artery patency]. / Wczesne I odlegle wyniki po udroznieniu tetnic wiencowych.

The role of percutaneous transluminal coronary angioplasty (PTCA) in the management of chronically occluded coronary arteries is still controversial. Percutaneous transluminal coronary angioplasty of chronic total occlusion is associated with relatively low success rates and a high incidence of restenosis. The purpose of this analysis was to determine, from the records of our institution, the efficacy and long-term outcome of angioplasty performed for chronic total occlusion defined as complete occlusion (Thrombolysis in Myocardial Infraction [TIMI] grade 0). PTCA was performed in 212 consecutive patients with chronically occluded coronary arteries and was successful in 125 (59%) patients. Complications were not observed. Successful initial PTCA was related to the clinical duration of occlusion and the type of guidewire (the primary success rate with the conventional guidewire was 49 (48%) versus 76 (69.1%) with Magnum Meier System p < 0.01). Repeat angiography was performed for 65 (52.0%) consecutive patients with successful initial PTCA and demonstrated restenosis in 34 (52.3%). 17 patients were successfully treated by a second PTCA. Restenosis or reocclusion was not clearly related to the residual stenosis post PTCA. In addition, the grade of collateral supply was not different in the vessels with and without restenosis.

Stepwise Inoue balloon catheter valvuloplasty for congenital aortic valve stenosis: comparison with standard balloon catheter technique.

Experience with stepwise balloon dilatation of congenital aortic valve stenosis using the new Inoue balloon catheter in 16 patients (aged 12 +/- 4.6 years; group II) is presented. Results are compared with those obtained in 15 patients (10 +/- 6 years; group I) in whom standard balloon catheters were used. The procedure resulted in a similar transvalvar gradient reduction in both groups (83 +/- 25 to 34 +/- 14 mmHg in group I versus 84 +/- 21 to 28 +/- 10 mmHg in group II). Significant aortic incompetence occurred in three patients from group I and in four from group II. There was no difference in the average increase in AR grade between the groups. At follow-up (group I, 24 +/- 13 months; group II, 7 +/- 3 months) there was no significant change in transaortic gradient or aortic incompetence. Balloon aortic valvuloplasty for congenital aortic stenosis carries a risk of aortic incompetence. Stepwise dilatation of the stenosis does not prevent this complication. The Inoue balloon catheter offers technical advantages.

Heart transplantation in an infant with rhabdomyoma.

Rhabdomyoma is the most common primary cardiac tumor in infants and children and is often associated with tuberous sclerosis. Surgical resection may be indicated and, if so, is usually curative. We describe a rhabdomyoma in an infant who presented with severe myocardial ischemia necessitating orthotopic heart transplantation.

Long term follow up after percutaneous mitral commissurotomy with the Inoue balloon-incidence of restenosis.

UNLABELLED: The long term outcome of 300 consecutive patients following percutaneous mitral commissurotomy (PMC) with the Inoue balloon was analyzed with regard to the incidence of restenosis. There were 256 females and 44 males (mean age 44.4 +/- 9.9 years, range 18-69 years), 52 had previous surgical commissurotomy, 96 were in atrial fibrillation, and 16 had a history of embolism. PCM was carried out with a success rate of 84% (no significant mitral regurgitation and mitral valve area (MVA) > 1.5 cm2). Two hundred and seventy patients were available for clinical and serial echocardiographic studies at six months, 12 months and once a year thereafter (18 patients operated on for mitral regurgitation less than six months after PMC, three patients lost to follow up, nine patients refused to return). MVA increased with PMC from 1.18 cm2 +/- 0.3 to 2.0 +/- 0.3 cm2 and then decreased to 1.8 +/- 0.3 at a mean follow up of 24.0 +/- 13.5 months (range 6-55). Echocardiographic restenosis (RS) (MVA at follow up < 1.5 cm2 with a 50% loss of the initial gain) was found in 38 patients (14%). Twenty-five (66%) of them remained in NYHA class I or II. Restenosis free survival according to the Kaplan-Mayer curve was 93%, 86%, 77% and 73% at 12,24,36 and 55 months respectively. None of the 24 clinical, hemodynamic, echocardiographic or procedural variables used on the Cox proportional hazard regression analysis identified predictors of restenosis free survival. CONCLUSIONS: The overall incidence of echocardiographic restenosis post PMC is low (12.6%) in patients followed for a mean period of two years and often occurs without worsened clinical symptoms. It may be difficult to define clinical, echocardiographic or procedural factors as significant predictors of restenosis free survival.

Reversal of ischaemic systolic and diastolic left ventricular dysfunction by successful coronary angioplasty in patients with non-Q wave anterior myocardial infarction.

The effect of PTCA on global and regional left ventricular systolic function, isovolumic relaxation, chamber and muscle stiffness were studied in 30 patients with angina pectoris, previous non-Q wave anterior myocardial infarction (AMI) and significant stenosis of the left anterior descending coronary artery (LAD). In 11 of the 30 patients the condition was stable, but it was unstable in 19. Left ventricular angiograms were obtained before and 4.85 +/- 3.67 months after PTCA. The RAO was in the 30 degree projection, with the silhouette of the left ventricle sliced into 90 regions; changes in left ventricular volume, pressure and anterior wall thickness during the full cardiac cycle, together with dp/dt were demonstrated. After PTCA, global ejection fraction increased from 68.77 +/- 5.96% to 76.57 +/- 3.18%, P < 0.001. Impaired contractility was found in 29/90 (32.2%) regions before PTCA and in 5/90 (5.6%) after PTCA, P < 0.001. The time constant of the isovolumic pressure fall decreased after PTCA (52.56 +/- 17.40 ms vs 39.61 +/- 11.26 ms, P < 0.01). Elastic chamber stiffness coefficient decreased (0.022 +/- 0.003 vs 0.008 +/- 0.004, P < 0.001) and peak rate of left ventricular filling increased (319.0 +/- 107.9 ml.min-1 vs 396.8 +/- 201.4 ml.min-1, P < 0.05) after PTCA. The muscle stiffness coefficient was within normal values before and did not change after PTCA. The study findings show that in patients with persistent angina pectoris after non-Q wave AMI, complex systolic and diastolic ischaemic dysfunction occurs. This dysfunction can be reversed after successful PTCA of LAD.

[Familial dilated cardiomyopathy with autosomal mode of inheritance. Case report]. / Kardiomiopatia rozstrzeniowa z dominujacym autosomalnym sposobem dziedziczenia. Opis rodziny.

Familial occurrence of dilated cardiomyopathy is estimated by 2-20%. We present a family with dilated cardiomyopathy inherited in an autosomal dominant way. We examined 9 members of the family, most of them are asymptomatic.

[Complications of percutaneous transluminal coronary angioplasty (PTCA)]. / Powiklania zabiegów przezskórnej sródnaczyniowej koronaroplastyki (PTCA).

Between 1981 and 1990, 714 patients underwent 756 percutaneous transluminal coronary angioplasty (PTCA) procedures. A total of 52 patients (6.9%) had major in-hospital complications: 5 patients (0.66%) died, Q-wave or non Q-wave myocardial infarction were observed in 13 patients (1.66%) during procedure and in 8 (1%) outside the catheterization laboratory, before discharge. Because of periprocedural occlusion 11 patients (1.5%) were managed with bypass surgery, 8 (1%) had a transient occlusion that was reopened with PTCA. 21 patients (2.8%) were not ++re-dilated but managed pharmacologically. Dissection, intracoronary thrombus and previous thrombolytic treatment were often associated with occlusion. The risk of dissection was related to lesion morphology. Long-(more than 1 cm) lesion, eccentric stenosis and tortuosity of the vessel segment undergoing dilatation were risk factors for occlusive dissection. There was a high risk of side branch occlusion if its take-off was narrowed and side branch originated from the target lesion. One of the most important risk predictors is the amount of jeopardized myocardium supplied by the target coronary artery. Acute closure of an artery supplying large amount of myocardium may cause abrupt hemodynamic collapse. Hypotension secondary to the artery occlusion may cause a decrease of the flow in the other coronary arteries, leading to cardiogenic shock. Although it is important to note that patients with unstable angina, intracoronary thrombus, long and complex lesion, severe multivessel disease and compromised left ventricular function are at higher risk of acute complication, PTCA is a relatively safe procedure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Percutaneous transluminal coronary angioplasty in patients with high risk bypass surgery]. / Przezskórna angioplastyka wiencowa u chorych z wysokim ryzykiem leczenia operacyjnego.

The purpose of this study was to assess the immediate and long-term results of incomplete percutaneous transluminal coronary angioplasty (PTCA) in high-risk coronary artery bypass surgery (CABG) patients. 24 pts (male-22, female-2, age - 39-60 years) were divided into 2 groups: I-8 pts with unstable angina pectoris who were definitely not CABG candidates because of very low ejection fraction (LVEF < 24%) and/or diffuse coronary atherosclerosis; II-16 pts selected for CABG only after failed PTCA. From this group 12 pts with unstable angina pectoris and history of myocardial infarction were at higher CABG risk because of LVEF < 40% and diffuse coronary atherosclerosis. 4 pts were poor surgical candidates because of coexistent medical disorders. The strategy of PTCA was to dilate first the most critical (culprit) lesion, responsible for the patient symptoms, usually situated in the artery supplying large area of viable myocardium. We did not achieve: complete revascularization in all our pts (incomplete revascularization by intent). Initial success rate of the PTCA in both groups was 100%. There were no serious complications. During follow-up (6 months--4 yrs) long-term clinical improvement was observed in 7 pts from group I (87.5%) and 14 pts from group II (87.5%). We conclude, that in most pts with unstable angina pectoris and with high-risk of CABG good immediate and long-term results of incomplete PTCA can be achieved.

[Percutaneous pulmonary valvuloplasty in 135 patients]. / Przezskórna walwuloplastyka plucna u 135 chorych.

We present our 7 years experience with 135 pts aged 1.4-44 years (mean 10-yrs) in whom percutaneous balloon valvuloplasty (BPV) for congenital pulmonary stenosis was attempted. In 4 pts we failed to place the balloon at valvar level, in another four BPV was repeated so, 135 procedures in 131 pts were performed. Balloon diameter/pulmonary anulus diameter ratio (BD/PD) ranged from 0.9 to 1.85 (mean 1.37). In 10 cases double balloon technique was used. Immediate results: in the whole group of 131 pts the right ventricular-pulmonary artery gradient (RV-PAG) was reduced from 74 +/- 42 to 34 +/- 34 mm Hg, and right ventricular systolic pressure (RVSP) decreased from 92 +/- 41 to 54 +/- 34 mm Hg just after BPV. 86 pts (65.6%)--group I, had good immediate result of BPV (RVSP less than 50 mm Hg). 4 of them had dysplastic pulmonary valves (DPVs). RV-PAG in 82 pts with normal valves decreased from 53 +/- 25 to 15 +/- 7 mm Hg right after BPV. In 45 pts (34.4%)--group II, immediate result of valvuloplasty was recognised as unsatisfactory (RVSP greater than or equal to 50 mm Hg): in 4 of them BD/PD was smaller or equal 1.2 (subgroup IIa); 34 others had significant subpulmonary obstruction (SPO) that appeared or increased after BPV (subgroup IIb); and in remaining 7, DPVs were noticed (subgroup II c).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison of rapid tests for assessing UHT milk sterility.

Samples of UHT milk were contaminated at two levels (10(2) and 10(4) cfu/ml) with 52 bacterial strains associated with spoilage. Samples were assayed, using various tests, to determine efficiency in detecting non-sterility after an incubation period shorter than that advised in standard procedures. The tests performed were colony count, titratable acidity and pH modification, organoleptic assessment, stability towards ethanol (68, 80 and 88% v/v), resazurin and nitrate reduction. After 3 d incubation at 30 degrees C every case was detected by the resazurin test with a good statistical probability (P = 0 x 999). Reliability was not so high in all other tests, even after 14 d incubation.